Recommended treatment for PCOS and endometriosis?

Thank you for your time and expertise. I am 43 years old, was diagnosed with PCOS when trying to conceive 15 years ago. Had four children—twins after IVF and two without IVF. I am 5’7” (170 cm) and weigh 146 pounds (66 kilos) with BMI around 23. I feel great when I weigh around 135 pounds (61 kilos), so trying to lose around 10 pounds (5 kilos).

I have been in ketosis for ten weeks and have had three menstrual cycles while in ketosis (average length around 23 days—with ovulation usually between days 9-11). During the 7-10 days leading to my period, I have outrageously strong food cravings—have literally had dreams that I am eating a tray of cupcakes. I also experience night sweats during the week prior to menstruation and regularly gain 8-10 pounds of water weight during this time. My body feels pretty miserable, but the extremely low mood I also used to experience during this week is gone since starting keto, so that is a huge win!

While I have not caved into eating carbs during the cravings, I feel intensely driven to eat during this premenstrual week only and any pounds I have lost during the other days of my cycle get put back on.

Each cycle I feel pretty awful from day 16 (cravings hit me like a truck) to day six (water gained has finally left my body and I feel like myself again). So I have about nine days or less each month where I feel like a healthy, normal person, and about 14 where I feel pretty awful.

I have checked my fasting blood sugar and blood ketones every morning for the past ten weeks and have not dropped below 1.0 mmol/L and no blood sugars above 100. During the nine or so days that I feel really good, morning blood ketones are around 2.0-3.0 mmol/L with blood glucose in the 70s. Closer to my period ketones get closer to 1.0 and blood sugars get into the 90s.

Any advice or insight that might help me have more good days than bad? I feel like my period derails my life and my progress and that it is coming so frequently now I am having trouble keeping my head above water! Thank you again for your time.

So my husband and I have been trying to get pregnant for over six years now. I have endometriosis, probably PCOS or hypothalamic dysfunction and probably low estrogen according to your responses to other women. I’m 29 years old, 5’2” (157 cm) and 123 pounds (56 kilos). I had laser surgery for the endometriosis five years ago with no reduction for pain. I remember seeing all of the cysts on the ultrasound and I can feel the pain on my sides sometimes throughout my cycle. No one ever told me I may have PCOS/hypothalamic dysfunction, but I have also noticed hirsutism and my cycles are monthly, but never average out (anywhere from 26-35 day cycles). I am unable to make it through a cycle without ibuprofen for menstrual pain. Tylenol doesn’t touch the pain.

I read on your website that you recommend laparoscopic excision for endometriosis rather than the laser treatment. Do you think that LAPEX surgery, keto diet and estrogen supplementation would be a good route for me to look into? As you said, many doctors aren’t offering the same support as you’ve recommended. I was always told that my cycles and levels were “normal” and pregnancy would happen any month now (that was five years ago). Can you recommend a blood test list of what to test and normal ranges for estrogen/androgen/etc that I can request from my local ob/gyn?

Honestly, we aren’t crazy about IVF and we felt like we had exhausted our options and were ready to forget fertility and grow our family through adoption instead, but after reading what you have to say about endometriosis and PCOS treatment I am wondering if there are still treatments other than IVF (surgery/supplements/lifestyle changes) that may be worth pursuing. Have you seen women with my host of issues get pregnant after this long without IVF?